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Useful Questions to Ask Before Enrolling in Medicare

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Useful Questions to Ask Before Enrolling in Medicare

Friday, July 7, 2017 10:12 AM

Choosing a Medicare health insurance plan is a big deal! You deserve to feel comfortable with your decision and confident that all of your questions and concerns have been addressed and answered. Before enrolling in Medicare coverage during your Initial Enrollment Period (IEP) or making changes during Medicare’s Annual Enrollment Period (AEP), make sure you have all the information you need to make an informed decision that you feel good about.

Consider the Following Questions:

What types of benefits do you need? You have a couple options available when deciding on a Medicare health insurance plan. You can either get your Medicare Part A and Part B benefits from Original Medicare (administered by the federal government) or you can get them through a Medicare Advantage Plan (MA) offered by a private insurance company.

If you get Part A and Part B through Original Medicare, you should consider your overall healthcare coverage needs. Although Medicare does cover many costs, many individuals choose to supplement this coverage with a Medigap policy to help pay some of the out-of-pocket expenses. Each of the 10 standardized Medigap policies A-N offer a different benefits package, premium, and out-of-pocket expense.

You may also want to consider adding a Medicare Part D prescription drug plan to your Original Medicare plan to help cover the costs of medications you may need.

Or you might choose a Medicare Advantage Plan that not only includes the same Part A and Part B benefits as Original Medicare, but also may offer an array of additional benefits, including prescription drug coverage. For more details on different Medicare plan types, click here. Costs and benefits of MA plans can vary, so it is important to compare plans before enrolling.

What can you afford? Decide what you are comfortable paying for premiums, deductibles, copayments and coinsurance. It is important to plan ahead so that any unexpected medical crises will not have a long-term effect on your financial security. Monthly premiums for Medigap and Medicare Advantage plans vary. Medicare Advantage plans are often more cost effective than adding Medigap coverage and Part D Prescription Drug Coverage to original Medicare. However, by purchasing a highly comprehensive plan with a higher premium such as Medigap Supplement Plan F, which covers the most benefits, there’s a chance it can keep costs lower in the long run.

Do you need to visit a specific doctor or pharmacy? If you have a preference for which doctors, providers, specialists, hospitals, or pharmacies you visit, find out if they are in the plan’s network or assignment. If you get benefits from Original Medicare, you may go to any doctor, provider, or supplier that accepts assignment. If you choose a Medicare Advantage Plan, you often have to visit providers within that plan’s network, otherwise you may need to pay more to visit those not on the plan’s list. Whether you choose between Original Medicare or Medicare Advantage, find out if your plan will cover the visit to your preferred doctor or pharmacy.

Do you need prescription drug coverage? This question poses a dilemma for many healthy individuals considering whether they need prescription drug coverage when it is first available to them. Even if you do not require any medications at this time, it is important to consider health issues that may arise in the future. If you do not enroll in drug coverage when you are first eligible, you may incur a late enrollment penalty when you eventually sign up for one.

If you are currently taking prescription medications, you might decide that you need prescription drug coverage. However, check if your drugs are on the plan’s formulary because each Medicare plan has its own list of covered drugs, often falling into different "tiers" and costs.

How was your past year? If you are considering changing plans during Medicare’s Annual Enrollment Period (AEP), think about your past year. Did your current healthcare coverage meet your needs during this past year? Did you face changes in your health, budget, or lifestyle? Have you been comfortable with your costs, including your out-of-pocket expenses? AEP is a great opportunity to explore your options and make sure you continue to have healthcare coverage that fits your needs, now and in the year ahead. Make your final decision and enroll before AEP ends on December 7.

 

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Last Revised 11/15/2017